GNUR 237 Nutrition Exam Study Guide

GNUR 237 Nutrition for Nursing Practice
Final Exam Study Guide
GNUR 297 Exam 2 Study Guide
Kcal per kg: carbs-4, protein-4, fat-9
BMI: (weight lb. / height in / height in) x 703 or kg/m^2
Tube Feeding Goal Rate Equation: (calories needed) / (concentration of formula) / (total hours
feeds will be given) = goal rate
Chapter 15 – Diabetes
Understand the clinical complications of DM
Macrovascular:
- CAD
- Peripheral Vascular Disease
- Stroke
Microvascular:
- Nephropathy
- Retinopathy
- Neuropathy
- CKD
Pregnancy:
- Congenital malformation
Dental:
- Periodontitis
Endothelial:
- Atherosclerosis
- Fungal infection (candida)
- Bullosis diabetciorum (diabetic blisters)
- Diabetic dermopathy (light brown scaly skin)
- Digital sclerosis (waxy hands)
Know what individuals are at greatest risk for diabetes (both adults and children)
- Children with Type 1 diabetic parents

- African Americans/Hispanic
- Obese/overweight patients
- Family history of Type 2 DM
- Prediabetes indicators
- Gestational diabetes during pregnancy
Understand metabolic syndrome and the ATP III guidelines for defining metabolic
syndrome (you need to have three out of five of them to be dx w/metabolic syndrome)
Metabolic Syndrome is marked by presence of 3 or more of the following:

- Increased BP (> 120 / 80)
- High blood sugar (A1c greater than 6.5)
- Excess fat around waist (> 40 / > 35 in)
- High LDL (GTE 150 mg/dL)
- Low HDL (< 40 mg/dL)
Goals for pre-prandial, peak post-prandial bsl in type 1, type 2, and gestational dm
Type 1 DM
- Pre-prandial (before meal): 90-130 mg/dL
- Post/Peak-prandial (after meal): <180 mg/dL
Type 2 DM
- Pre-prandial (before meal): <110 mg/dL
Gestational DM
- Pre-prandial (before meal): <95 mg/dL
Know what HbA1c measures, and goals
Combination of glucose and hemoglobin in blood stream. 120-day life span so good measure of
glucose levels besides SMBG.
6% = 120 mg/dL
7% = 150 mg/dL
8% = 180 mg/dL
Goals:
Before meal: 70-130 mg/dL
Two hours after meal or peak: <180 mg/dL
Bedtime: 90-150 mg/dL
Know the MNT for type 1, type 2, and gestational dm
Type 1, insulin dependent

- Individualized plan
- Monitoring cholesterol and fats (LDL, HDL, triglycerides)
- These patients are at risk for the 3 P’s (polydipsia, polyuria, polyphagia)
- Insulin therapy in combination with carbohydrate counting
- Monitoring BG
- Exercise metabolic control, 100-200 mg/dL is ideal
Type 2, insulin resistant

- Oral glucose lowering medications
- BG monitoring
- Diet and exercise

- Meal planning
- Monitoring cholesterol and fats (LDL, HDL, triglycerides)
Gestational DM
- Diet and meal planning, weight control
- Limit carbohydrates to 35-40% of total calories
- Increased folic acid supplementation as compared to non GDM pregnancy but then
reduced after 12 weeks to normal requirements
Understand how carbohydrate counting is used in diabetic meal planning

Combines blood glucose monitoring and carbohydrate control
- Target blood glucose: 90-130 mg/dl before meal
- Correction factor: 1 unit of short acting insulin for every 50 mg/dl over target
- 1 serving of CHO = 15 grams of
o 1) Set ratio for the meal
o 2) Monitor blood glucose and add or subtract insulin based on blood glucose
o 3) Use insulin to cover carbohydrates and correct blood glucose
Example:
Target BG is 90-130 mg/dL, actual BG is 170 mg/dL need to add 1 unit of insulin
before meal
Know how exercise affects bsl in a diabetic and appropriate pre and post workout
recommendations
Exercise lowers blood glucose levels and is not a problem for DM patients if monitored.
- Should be avoided if BG is GTE 250-300 mg/dL
- Ingest carbs if below 100 mg/dL
- Do not exercise at peak insulin
- Evidence of ketones in urine or ketosis
- Ideal BG level for exercise is 100-200 mg/dL
DM patients should be able to identify BG response to exercise conditions and act accordingly.
Understand the 15-15 rule to treat hypoglycemia
15g of carbohydrate repeated every 15 mins to maintain or reach BG level, use of simple carb,
like juice.
Chapter 16 – Stress
Know how the body differs in its response to stress versus starvation
Hypometabolic State: Inadequate energy / nutrient intake, body is using and in taking less
calories, BMR decreases
- Alternate fuel sources (glycogenesis, ketones/FFA)
- BMR downshifts to conserve energy
- Impaired function (immune sys, respiratory, etc.)
Hypermetabolic State: result of multiple fractures, burns, sepsis, major surgery/injury, body
needs more calories, BMR increases
- Ebb phase: 0-36 hrs. after injury
o body is maintaining blood to vital organs
o decreased oxygen consumption,
o decreased CO
o hypothermia
o lethargy
- Flow phase: 36-48 hrs.
o increased O2,
o Hyperthermia
o Increased CO
o nitrogen excretion
o hyperglycemia
o expediated catabolism to meet metabolic demands

Be able to calculate the calorie needs of a critically ill patient (25-30 kcal/kg)
Used for critically ill patients, though not effective/best means as overfeeding is more
detrimental to these patients then underfeeding. (weight x kcal)
obese patients - 21 kcal/kg

underweight- 30-32 kcal/kg
critically ill- 25-30 kcal/kg
Understand the purpose of a doing a nitrogen balance test on a patient and what it means
to be in a positive or negative nitrogen balance
Used over 24-hour period, using protein consumed, collecting urine sample measuring the Urine
Urea Nitrogen to come up with a + or - number ensuring they are in a positive nitrogen balance
and synthesizing proteins properly
- Positive nitrogen balance is associated with periods of growth, hypothyroidism, tissue

repair, and pregnancy.
- Negative nitrogen balance is associated with burns, serious tissue injuries, fevers,
hyperthyroidism, wasting diseases, and during periods of fasting.
Know the difference between marasmus and kwashiorkor
Kwashiorkor- protein deficiency characterized by edema, growth failure, and muscle wasting,
skin breakdown, delayed wound healing
Marasmus- absolute food deprivation (protein, carbs, etc.), no edema, thin appearance
Be able to define refeeding syndrome, its characteristics, and who is at risk for refeeding
Reintroduction of nutrients to malnourished person too rapidly causes potentially lethal, severe
electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients.
Can also be patients with chronic alcoholism, gastric bypass / post-op patients, oncology
patients.
Chapter 12- Food Related Issues / Metabolic Stress
Know the differences between enteral and parenteral nutrition, indications and
contraindications for each, risks associated along with advantages of both methods of
nutrition support
Enteral: Anytime GI tract is used to provide nourishment (mouth or tube)

- Indications:
o Anytime GI tract is functional, accessible and safe to use as it maintains integrity
and function of the gut.
o Dysphagia, burns, intestinal fistulas, renal dysfunction, radiation therapy
- Contradictions:
o Hemodynamic instability, bowel obstruction, high-output fistula or severe ileus
- Advantages:
o Costs less than parenteral
o Promotes gut health/function
o Less chance of infection
- Disadvantages:
o Complications with tube placement
o Aspiration
o Diarrhea
o Underfeeding
o Obstipation
o Spasm/flatulence
Parenteral: energy and nutrients delivered intravenously

- Indications:
o Nonfunctioning GI tract or required bowel rest
o Severe malabsorption
o Obstruction or ileus
o GI bleeding
o Bowel ischemia
o Radiation enteritis
o Short bowel syndrome
o Pancreatitis or colitis
- Contradictions:
o Whenever GI is functioning and accessible, safe.
- Advantages:
o Central access
o Entire nutrient needs can be meet with complete formula
o Can be used for weeks to years
- Disadvantages:
o High risk for infection, direct link to right side of the heart
o Costly
o GI atrophy
o Sepsis
o Embolism or Thrombosis formation
o Electrolyte imbalances
Know the most serious complication associated with enteral feedings (aspiration) and ways
to prevent it
- Check tube placement before administration
- Tubes placed into small bowel are less likely to aspirate
- Elevate head of bed 30-45 degrees
- Added food coloring to allow for detection of aspirated feeding/pulmonary secretions
Understand other complications of enteral feeding and how best to manage them (i.e.
underfeeding, diarrhea, high gastric residuals)
- Diarrhea
o Hand washing, room temp feeding, dilute hyperosmolar solutions, check
medications and antidiarrheic use
- Nausea/vomiting
o Hand washing, reduce rate of administration, change bypass devise
- Spasm/Flatulence
o Reduce rate of administration, elevate upper part of body during food intake. Use
low lactose-low fat tube feed diets.
o Check GRV (gastric residual volume accumulations), <500mL stop TF
- Obstipation
o Increase fluid supply
- Patency of tubing
o Irrigate
- Medications
o Never crush time released or eccentric coated
o Do not give sublingual
o Liquid form
- Bacterial contamination
o Do not hang feedings longer than 4-8 hours
o Never add new to old formula
o Change bag daily
Have a general understanding of the advantages/disadvantages with each of the different

routes of enteral feeding (NG tube, NJ tube, G tube, J tube)
NG-tube
- Nose to stomach
- Normal gastric function
- Easy to place
- TF < 1 month
- Greater risk for aspiration
- Gastric emptying can be monitored
OG-tube
- Mouth to stomach
- TF < 1 month
NJ-tube
- Nose to jejunum
- Aspiration risk/gastroparesis
- Cannot monitor gastric motility
- Requires endoscopy
- TF < 1 month
G-tube or PEG
- Stomach tube
- Bolus feeding and medication administration
- Potential for dislodgement and aspiration
- Stoma care required
- TF > 1 month
J tube
- Jejunum tube
- Smaller tube may clog

- Stoma care required
- Aspiration risk/gastroparesis
- TF > 1 month
Know when an elemental tube feed formula would be appropriate
Considered a standard formula (intact nutrients that require GI tract function), however
elemental formula is predigested/hydrolyzed nutrients and can used for patients that have
impaired GI function or ability to absorb nutrients.
Know when it is appropriate to give a patient continuous vs intermittent vs bolus feed
Continuous: most common, controlled delivery of prescribed volume or formula at constant rate
using a pump and simulates gastric emptying.
- Patients who have not eaten for a long time
- Debilitated patients
- Impaired GI function
- Uncontrolled type 1 DM
Intermittent: total quantity is done 3-6 times in a 24-hour period, delivered by gravity, more of a
normal feeding pattern, can be too rapid and requires constant monitoring.
Bolus: infusing volumes of formula by gravity or syringe over short periods. Hi risk for
aspiration, regurgitation and GI side effects.
- Only appropriate for stomach feeding
Be able to calculate tube feeding goals
calories required / concentration of formula / total hours feed is to be given = goal rate
Chapter 11 – Nutrition Assessment and Patient Care
Know the physiological effects of malnutrition in a patient care setting
2 criteria:
- insufficient energy intake
- weight loss
- loss of muscle mass
- loss of subcutaneous fat
- localized or generalized fluid accumulation
- dimished functional status (hand grip strength)
Physiological effects:
- increased morbidity and mortality
- bed rest decreased muscle loss, glucose tolerance, function
- compromised skin integrity

- poor wound healing
- increased infections rate
- metabolic stress further depresses
Know the ABCD’s of a nutrition assessment

TJC requires nutritional assessment within 48 hours of admittance.
Anthropometrics- simple, noninvasive techniques to measure height, weight, head circumference

and skin folds.
BMI, Waist Circumference, etc.
Biochemical- routine blood and urine lab tests and results to be recorded in patient charts and
used for objective assessment of nutrient status.
This is not an end all be all indicator, ex. Albumin
Visceral proteins, Immune function vitamins
Clinical assessment- data from medical history, social history and physical examination and can
identify nutrition deficiencies/requirements.
Skin changes, hair loss, family history, socio-economic status, etc.
Dietary intake assessment- data collected using dietary recall method or documented food
records
24-hour recall, food records, calorie counting by nurse, etc.
Have a general understanding of what would cause a patient to be at nutrition risk

- age
- disorder severity
- feeding mode (NPO / tube feeding)
- weight
- food deserts
- drug interactions
Know the formulas for BMI, % usual body weight, and % weight change and be able to
use them. Be able to identify if a calculated weight change is significant, or insignificant
BMI
- kg/m^2 or [weight (lb.) / height (in) / height (in)] x 703
% of Usual Body Weight

- (actual weight / usual body weight) x 100 =
% Weight Change
- (Usual wt. - actual wt.) / Usual weight x 100 =
- unplanned loss of 10% or more: significant for malnutrition

Know the indicators used to identify visceral protein status, and the disadvantages and
advantages of using them in a nutrition assessment
Proteins found in internal organs and blood; these proteins aren’t found in muscle. The visceral
protein status is estimated through tests of serum albumin and prealbumin.
<3.5 g/dL albumin 10-15 g/dL preablumin
- Disadvantages- serum albumin decreases in presence of inflammation, so not accurate

representation.
- Advantages- some believe low serum albumin level indicates a need for protein repletion.
Ease of measurement, low cost, reproducibility, excellent predictor of surgical outcomes,
consistent response to interventions. Low serum is also indictive of morbidity/mortality
prognosis
Chapter 10 – Nutrition across the Life Span
To reduce infant mortality, we need to decrease the number of infants born of an LBW.
Identify modifiable factors to reduce the likelihood of an LBW or preterm infant
Modifiable factors:
- Underweight prior to or during pregnancy
- Smoking
- Iron deficiency
- Compromised immune system
Failure to Thrive (FTT)

- Drop of 2 standard deviations in weight gain over 2 months or longer in infants
younger than 6
Understand the medical nutrition therapy (MNT) involved with management of

nausea/vomiting, constipation and heartburn in a pregnant woman
Nausea/Vomiting:
- Occurs at all times of the day
- Hyperemesis gravidarum- Electrolyte imbalances, dehydration, weight loss
Management:
- Separate liquid and solid food intake
- Small frequent meals
- Avoid odors and foods that trigger nausea
- Vitamin B6
Heartburn:
- Results of relaxed GI system secondary to progesterone
Management:
- Ingestion of small, frequent meals
- Avoid laying down after a meal
- Limit high fat and spicy foods

Constipation:
- Results of relaxed GI system
- Increased incidence of hemorrhoids
Management:
- Consume 30 grams fiber/day
- Laxatives are NOT recommended
- Bulk forming fiber supplements with water (Metamucil)
Know how calorie needs change during both pregnancy and lactation and why
BMR increases by 15-20% due to physiological changes:

Blood- hemodilution (BV increase)
Circulatory- increased output
Respiratory- increased tidal vol. and O2
GI- relaxed tract and slower motility
Renal- insulin resistance, increase GFR, fetus prefers glucose
Immune- suppressed
Organ and tissue enlargement
First Trimester- no additional calories

2nd Trimester- 340 calories
3rd-4th trimester- 450 calories
Lactation- 500 calories
Nutrient requirements:
Protein 71g/day
Folate
Calcium
Iron 27 mg/day
Know what fat is of importance when pregnant and why
DHA and Omega 3 which helps promote fetal vision and neurological development
Understand the issues of food safety with pregnant women and corresponding
recommendations
Tetragons:
Avoid alcohol, drug use and smoking
Limit caffeine to < 200mg/dg
Foodborne illnesses: listeria, salmonella, toxoplasma

Deli meat, unpasteurized dairy, foods high in mercury, raw shellfish, undercooked meats,
soft cheeses, raw sprouts
Consider reheating deli meats in microwave, refrigerate smoked salmons/seafood, etc.
Understand the benefits and recommendations for breastfeeding
First 6 months ideal for first 12 months, 10-12 times per day
- prolactin is responsible for triggering lactation
- supply and demand mechanism
- 71 g protein, 500 kcal needed (1800 kcal minimum)
- 750-1000mL of milk produced daily
Benefits:
- Cost/convenience
- Bonding
- Bioavailability and immunologic factors (colostrum)
- Decreased incidence of chronic diseases and infections in newborns
- Decreased risk of breast cancer
- Reduces risk of food allergies
Should be avoided:
- Tuberculosis
- HIV
- Hep C
- HSV on breasts
- Alcoholism/drug addiction
- Malaria
- Breast Cancer
- Maternal Chickenpox (first 3 weeks)
Know when the AAP recommends, we start a baby on solid foods, how we know they are
ready, what the first foods should be and why
4-6 months introduction

- breast milk is still major source
- requires physiological and developmental movement
- one food at a time, every 4-5 days
- start w/iron fortified cereals, then add PLAIN veggies/fruits
- can slowly introduce chopped fruits/veggies, water and juice at 6-8 months (4-6 fl oz
per day)
9-12 months self-feeding

- mashed, ground meats, grain products
- egg yolk
- cut up pieces of fruit
- cottage cheese, yogurt
- crackers, toast, cereals
Know what not to feed infants (honey, choking hazards, > 4-6 oz juice, etc.) and why
Honey: Botulism
Excessive formula or breast milk
High risk foods for choking: Hot dogs, grapes, popcorn, raw carrots, nuts
Cow’s milk: body can’t digest fats yet and shouldn’t be getting that type of fat till 2 years of age
Too much juice: sugar content
Know common food allergies

Eggs, Wheat, Peanuts, Tree nuts, Soy, Seafood, Cow's Milk
Know the concept of “division of responsibility”

Parents: What and When to eat
Child’s: How much to eat
Understand common issues with toddlers and preschoolers when it comes to nutrition and
techniques/strategies to resolve issues (i.e. picky eating)
Defined as ages 1-3
- increased protein
- increased milk consumption
- some fat restriction
- Nutrient Dense Meals
- Child Size portions
- snacks are important
- Role models
- New foods: 10x before acceptance or different ways
Picky eating techniques:

- Eat well during pregnancy and lactating
- Get in lots of variety
- Make unfamiliar foods familiar
- Be a good role model
- Make time for family meals
- Engage the child in the process
- Avoid feeding on demand
- Refrain from labeling them as “picky eaters”
- Avoid overpraising healthy eating.
Understand iron deficiency, reasons why it may occur and how to prevent it from
occurring, and its effects on the health of the child
- Milk/Juice Anemia- Iron deficiency seen in toddlers due to excess juice / milk causing fullness
and not having enough iron from (fortified cereals, animal proteins, plant proteins) which can
lead to lead poisoning / increased lead absorption
- Can also be deficient in calcium and zinc (mineral to mineral interaction)

Know the health consequences of overweight and obesity in children
Premature Death
CVD
HTN
Osteoarthritis
Certain Cancers
DM
Understand the factors that are involved in adolescent food intake and common dietary
patterns we see within this groups
Calcium/Bone mineralization is important

- concern especially for teenage girls
Iron needs
- girls starting menstruating
- boys increased blood volume and lean body mass
-
Deficiency in Folate and Zinc may indicate alcohol use/abuse.
Common Patterns:
- Increased Snacking
- Skipping meals
- Eat away from home
- Consume fast food
- Dieting
- Anorexia, Bulimia, and binge eating
Be able to explain the physiological and metabolic changes that occur in early, middle, and
late adulthood and the nutrition implications with each (i.e. calcium and middle age
women, old age and vitamin B12)
Early Adulthood:
- Busy career, having and raising children all take a toll on health, including nutrition
and exercise.
- Growth completes by this stage and kcal decrease as well as daily calorie intake
(sports to a desk).
- 2900 kcal / 2200 kcal
- Increased protein requirements, 58-63 g
- Decreased calcium and phosphorus needs
Middle Adulthood:
- More time and funds to eat out.
- Decreased LBM, cells replication results in decrease in needed kcal.
- 2200 kcal / 1920 kcal

- Protein requirements remain the same while iron drops in women due to menopause.
Older Adulthood:
- Prior lifestyle and current lifestyle behaviors indicate quality of life (exercise, diet,
alcohol/tobacco use).
- Decreased income / fixed income may limit food options.
- B12 deficiency may lead to disorientation
- Easier to become dehydrated or incontinent
- Reduced BMI means possible risk for illness/disease
- Decreased need for protein
- Decreased ability for vitamin D synthesis requires more demand
- Intrinsic factors decreased B12 absorption, risk of pernicious anemia
- zinc deficiency may alter taste receptors.
Oldest Adulthood:
- decreased ability to absorb and/or synthesize nutrients (medications)
- concerns of malnutrition underweight, dehydration, nutrition screening
Chapter 9 – Energy, Weight, and Fitness
Understand the three components of total energy expenditure
Resting Energy Expenditure (BMR/REE)- energy required for normal function while at rest 60-
70% of total kcals
Physical activity- any body movement produced by skeletal muscles, 20-30% of total kcals
Thermic effect of food- energy required to digest, absorb, store food, 7-10% of total kcal
Know what factors affect RMR and how
Age, body size, sex, body temperature, fasting/starvation, stress, menstruation, thyroid function
Know different ways to measure an individual’s resting metabolic rate
Indirect calorimetry- measure respiratory gases.
Bod Pod- placing person in chamber, body heat given off reflecting energy used
Estimating based on weight- men: 40 kcal/kg women: 38 kcal/kg
Mifflin-St. Jeor Equation (accurate within 10%)
Men: (9.99 x actual weight) + (6.25 x height) - (4.92 x age) +5

Women :(9.99 x actual weight) + (6.25 x height) - (4.92 x age) -161
Know the benefits and recommendations for physical activity (the 2008 Physical Activity
Guidelines for adults and older adults, part of the 2010 DGA)
- 150 mins of at least moderate-intensity OR at least 75 minutes vigorous- intensity per week
- Muscle strengthening 2 times per week
Benefits:
- Lowers risk of heart disease, reduces risk of certain cancers, lowers BP, improves lipid
profiles, prevents obesity, prevents diabetes, enhances immune function, relieves stress,
improves mood, promotes self- esteem, improves cognitive health, and increases function
health
Know how to calculate BMI, categorize someone as normal weight, overweight etc. based
on their BMI, disadvantages or limitations/ advantages to using BMI
BMI: kg/m^2 (1 lb.= 2.2 kb, 1 in = 39.37)

Normal BMI: 18.5-24.9
Overweight: 25-29.9
Obese: Over 30
Disadvantages/limitations:
- Doesn’t account for those with high or low LBM (lean body muscle) such as athletes or
elderly
- Insensitive to small weight changes
Advantages:
- correlation between BMI and waist circumference linked to CVD and DM
- better measurement than weight alone
Know waist circumference, how it’s measured, and what WC makes an individual “high
risk”
Apple shape (android)- biggest around waist, indicator for morbidity/chronic disease
Pear shape (gynoid)- biggest in hips, thighs, waist
Waist to Hip Circumference (healthy)

- Men: <0.95
- Women: <0.8
Waist Circumference (healthy)

- Men: <40 inches
- Women: <35 inches
Know what medical conditions are associated with obesity

CVD, hyperlipidemia, HTN, DM 2, Sleep apnea, Depression, GI related cancers (colon, kidney,
etc.), Reproductive (miscarriage, stillbirth, preeclampsia), Fatty liver, Stroke
Know what amount (%) of weight loss has been proven to have positive effects on the
health of the individual (and what the positive effects are)
10% of body weight in 6 months

- Reduced risk of diseases associated with obesity
- Positive body image, improved mood, etc.
1 lb. of fat = 3500kcal
Know the common characteristics of weight regainers, those on the NWCR, and the
concept of taking a wellness approach to weight loss
NWCR: Monitors people who have lost 30 lb. and have maintained that weight loss for at least a
year.
Characteristics of successful weight loss:

78% eat breakfast
75% weigh once per week
62% watch less than 10hrs TV
90% exercise at least an hour per day
Characteristics of regainers:
Did not incorporate exercise
Radical diet changes
Not behavior focused
Lack social support
Wellness Approach to Weight Loss

Minimize use of food to meet emotional needs
Behavior changes
Eating frequently and regularly (3-5 times per day)
Food Journal
Adopt a healthy lifestyle
Know what the terms nutrient dense and energy dense mean
Nutrient dense- food that is high in nutrients but relatively low in calories. Contain vitamins,
minerals, complex carbohydrates, lean protein, and healthy fats.
Energy dense- Amount of energy per gram of food. Lower energy density foods provide fewer
calories per gram of food and vice versa.

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GNUR 237 Nutrition for Nursing Practice

Final Exam Study Guide

GNUR 297 Exam 2 Study Guide

Kcal per kg: carbs-4, protein-4, fat-9

BMI: (weight lb. / height in / height in) x 703 or kg/m^2

Understand the clinical complications of DM

- Children with Type 1 diabetic parents

Metabolic Syndrome is marked by presence of 3 or more of the following:

Know what HbA1c measures, and goals

Know the MNT for type 1, type 2, and gestational dm

Type 1, insulin dependent

Type 2, insulin resistant

- Diet and exercise

Understand how carbohydrate counting is used in diabetic meal planning

Understand the 15-15 rule to treat hypoglycemia

- Alternate fuel sources (glycogenesis, ketones/FFA)

- BMR downshifts to conserve energy

- Impaired function (immune sys, respiratory, etc.)

- Ebb phase: 0-36 hrs. after injury

o body is maintaining blood to vital organs

o decreased oxygen consumption,

- Flow phase: 36-48 hrs.

o expediated catabolism to meet metabolic demands

obese patients - 21 kcal/kg

- Positive nitrogen balance is associated with periods of growth, hypothyroidism, tissue

Know the difference between marasmus and kwashiorkor

Chapter 12- Food Related Issues / Metabolic Stress

Enteral: Anytime GI tract is used to provide nourishment (mouth or tube)

Parenteral: energy and nutrients delivered intravenously

Have a general understanding of the advantages/disadvantages with each of the different

- Smaller tube may clog

Know when an elemental tube feed formula would be appropriate

Know when it is appropriate to give a patient continuous vs intermittent vs bolus feed

Be able to calculate tube feeding goals

Chapter 11 – Nutrition Assessment and Patient Care

Know the physiological effects of malnutrition in a patient care setting

- compromised skin integrity

Know the ABCD’s of a nutrition assessment

Anthropometrics- simple, noninvasive techniques to measure height, weight, head circumference

Have a general understanding of what would cause a patient to be at nutrition risk

% of Usual Body Weight

- unplanned loss of 10% or more: significant for malnutrition

<3.5 g/dL albumin 10-15 g/dL preablumin

- Disadvantages- serum albumin decreases in presence of inflammation, so not accurate

Chapter 10 – Nutrition across the Life Span

Failure to Thrive (FTT)

Understand the medical nutrition therapy (MNT) involved with management of

- Limit high fat and spicy foods

BMR increases by 15-20% due to physiological changes:

First Trimester- no additional calories

Know what fat is of importance when pregnant and why

Foodborne illnesses: listeria, salmonella, toxoplasma

Understand the benefits and recommendations for breastfeeding

4-6 months introduction

9-12 months self-feeding

Know common food allergies

Know the concept of “division of responsibility”

Picky eating techniques:

- Can also be deficient in calcium and zinc (mineral to mineral interaction)

Know the health consequences of overweight and obesity in children

Calcium/Bone mineralization is important

- 2200 kcal / 1920 kcal

Chapter 9 – Energy, Weight, and Fitness