MNT EXAM III

MNT EXAM III

Summer is Just Around the Corner! You Can Do This!​

• Functions of the respiratory system and where they occur

• How the lung assist with immune health

• ​Nutrition status in relation to pulmonary disease

• Restrictive vs. obstructive lung disease​

• Nutrition needs and​ nutrition support in COPD and cystic fibrosis

• ​nutrition-related concerns of asthma

• ​physical symptoms associated with different pulmonary diseases

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​You're in section 1 of 5

​Lungs

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Multiple Choice

True or False. Nutrition status and pulmonary function are interdependent.

• true

• false

Open Ended

It's true. Nutrition status and pulmonary function ARE interdependent. Explain why.

Nutritional status and pulmonary function are interdependent. Explaination:

• macronutrients are metabolized using oxygen (and produce CO2)

• ​malnutrition can result from pulmonary conditions

• malnutr​ition leads to worse outcomes for pulmonary disease

  • ​affects respiratory muscle performance

  • affects lung structure

  • hinders defense mechanisms

  • predisposes pts to respiratory failure

Fill in the Blank

malnutrition associated with poor intake reduces the strength and endurance of respiratory muscles and lung _______.

Fill in the Blank

The major function of the respiratory system is...

Open Ended

List as many functions of the respiratory system as you can.

• synthesize ara​chidonic acid (that's omega-6!)

• ​convert angiotensin to angiotension II

• Immune defense ​

• gas exc​hange

• ​filter, warm, and humidify air

• ​synthesize surfactant

• ​regulate acid-base balance

Functions of the Respiratory System

How many did you get? ​

Multiple Select

How do the lungs aid in immune defense? Select all that apply.

• Traps particulates in sticky mucus

• propels mucus and unwanted visits out using cilia

• Alveoli cells engulf and destroy bacteria

• they collapse, thus crushing the bacteria

Multiple Choice

which cells secrete surfactant?

• alveoli cells

• ravioli cells

• epithelial cells

• yo mama cells

Fill in the Blank

Which enzyme, found within the lungs, is responsible for converting angiotensin to angiotension II?

Fill in the Blank

Where does gas exchange (the lung's #1 function) occur?

Open Ended

How can pulmonary disease affect dietary intake?

​How can respiratory disease affect dietary intake?

• early satiety

• anorexia

• ​weight loss

• coughing

• ​dyspnea (difficulty breathing) while eating

Multiple Choice

Energy requirements with pulmonary disease are significantly...

• increased

• decreased

Let's take a couple of deep breaths. Move along when you're ready. ​

​

​Time for a Break

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Open Ended

What is the difference between restrictive lung disease and obstructive lung disease? Give an example of each.

• difficulty exhaling old air

• ​ex: COPD - Emphysema and chronic bronchitis

​Obstructive

• have trouble fully expanding their lungs

• ex: ​pulmonary fibrosis

​Restrictive

Obstructive vs. Restrictive

Multiple Choice

Pulmonary fibrosis is an example of ______ lung disease.

• Obstructive

• Restrictive

Multiple Choice

People with this type of lung disease have trouble exhaling 'old air.'

• Obstructive

• Restrictive

Multiple Choice

An example of obstructive lung disease is...

• COPD

• Pulmonary fibrosis

Multiple Choice

People with this type of lung disease have trouble expanding their lungs fully.

• Obstructive

• Restrictive

Open Ended

How does cystic fibrosis affect immune health and the GI tract?

Open Ended

How does cystic fibrosis affect immune health and the GI tract?

​Cystic Fibrosis (CF)

• genetic disease that causes increased mucus production

• chronic cough and infection

• ​blocks movement of digestive enzymes to duodenum

  • lack of pancreatic enzymes -> malabsorption

  • trouble digesting f​at soluble vitamins

• Bowel obstructions

• damage of liver and pancreatic cells that leads to CF diabetes

Multiple Select

Symptoms of CF include...

• Chronic cough

• Dyspnea

• Wheezing

• Weight gain

Multiple Select

Select all of the most prevalent physical conditions associated with pts with CF in a nutrition deficit.

• Hair loss

• Edema

• Skin rash

• night blindness

Open Ended

Summarize everything you know about MNT for CF.

Multiple Select

Select the vitamins of concern in CF.

• A

• D

• C

• E

• K

Multiple Choice

True or False: Sodium should be restricted in pts with CF.

• True

• False

There is excessive sodium loss in perspiration in patients with CF. Therefore, sodium is not restricted. In fact, sodium needs are increased.

Fill in the Blank

Patients with CF should have regular nutrition assessments at __ month intervals.

Multiple Select

Select true statements about MNT for CF.

• Overnight EN may be needed to meet nutritional needs.

• Pts may need pancreatic enzymes.

• Energy needs are decreased in pts with CF.

• Energy needs are increased in pts with CF.

• pts with BMI <19 may need agressive nutrition support.

Fill in the Blank

Energy needs of pts with CF are increased by ___% to ___% of normal energy requirements. Enter answer as (XXX-XXX).

​Nutrition Support for CF

• Used to supplement intake, usually as nocturnal f​eedings

• ​gastrotomy or NG tubes

• ​calorie dense formulas, >1kcal/mL

  • ​pancreatic enzymes pre and post feeding

• ​semi-elemental formulas are less kcal but do not require pancreatic enzymes

Open Ended

Summarize nutrition support for CF.

​Nutrition Support for CF

• Used to supplement intake, usually as nocturnal f​eedings

• ​gastrotomy or NG tubes

• ​calorie dense formulas, >1kcal/mL

  • ​pancreatic enzymes pre and post feeding

• ​semi-elemental formulas are less kcal but do not require pancreatic enzymes

Open Ended

Summarize MNT for CF. What are the nutrients of concern? What would nutrition support look like? What are the nutrition-related goals?

Get up and move.​

​

​Break Time

​

Fill in the Blank

A smoker's vitamin C requirements are increased by __mg/d. (Enter answer as XX).

Fill in the Blank

The RDA for vitamin C in non-smokers is __mg/d. (Enter answer as XX).

Multiple Choice

True or false. High BMI is associated with increased asthma.

• True

• False

Open Ended

What are some tips you would give to a pt with asthma? Why would you give these tips?

1. higher BMI = more asthma

2. antioxidants reduce lung inflammation

3. allergies can trigger asthma

4. pts with asthma have low vitamin D

5. sulfites can trigger asthma​

​Why

1. maintain a healthy weight

2. ​eat lots of fruit & veg

3. ​avoid allergy triggering foods

4. ​consume adequate vitamin D

5. ​avoid sulfites

​Tips

MNT for Asthma: Tips

Open Ended

What are the symptoms of COPD?

Multiple Select

Assessment of a person with COPD should include:

• Weight status (BMI, Weight hx, etc)

• Body composition

• Indirect calirometry

• recommendation for a bone scan

• NFPE

  (barrel chest, clubbing, cyanosis, signs of malnutrition)

Multiple Choice

True or False. Calorie needs are always increased in those with COPD.

• True

• False

Fill in the Blank

People with COPD need ___-___g of protein/kg/d. (Enter answer as X.X-X.X).

Fill in the Blank

Macronutrients for COPD: Protein should make up __-__% of daily energy intake, fat __-__%, and carbs __-__%. (Enter answer as XX-XX, XX-XX, and XX-XX).

Open Ended

Your patient, Mike, has COPD with cor pulmonale. How will this affect his micronutrient intake goals?

Mike will need to be put on a fluid and sodium restriction because cor pulmonale is associated with fluid retention. If he also take diuretics, then his potassium needs are increased.

Multiple Select

(Select all that apply) Nutrition intervention for persons with COPD should focus on:

• maintaining and restoring optimal nutrition status

• preventing continued weight loss in malnourished pts

• preventing weight loss in all patients, even if overweight

• promoting weight loss for overweight individuals

• maintaining or restoring lean body mass

Open Ended

What are nutrition intervention strategies for COPD? List as many as you can think of.

Open Ended

Summarize nutrition support for COPD.

​Nutrition Support for COPD

• polymeric or hydrolyzed

• ​avoid overfeeding (>35 kcal/kg)

Open Ended

How would you monitor a client with COPD?

​Monitoring: COPD: Every Visit

• typical diet

• clinical data

• ​medication changes

• lifestyle influences

• ​QOL

• weight status

• ​body comp

Open Ended

Summarize MNT for COPD. Go through ADIME in your head.

Open Ended

What stood out for you in the lung section?

​give yourself a pat on the back.

​

All Done!

• ​Causes and Impacts of Parkinson's Disease

• ​Types of strokes and factors associated

• Tissue cell death in strokes

• ​Frazier water protocol

• ​Dysphagia

• ​Keto

• Major physical changes with Alzheimers​

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​Section 2 of 5

​Neurological

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Fill in the Blank

This protocol allows pts who are NPO or on thickened liquids to have ice chips/water between meals.

Multiple Choice

Select the requirment for a patient to qualify for the Frazier Water Protocol.

• no dysphagia present

• good oral hygiene

• high mental awareness

Multiple Select

What are the benefits to allowing the Frazier water protocol?

• Decreases risk of aspiration

• Increases pt compliance

• improves pt quality of life

• increases risk of aspiration

Multiple Choice

What level of dysphagia/dysphagia type would indicate eating foods that appear in this picture?

• Level 1 Dysphagia Puree

• Level 2 Dysphagia Mechanically Altered

• Level 3 Advanced Dysphagia

Open Ended

Give examples of foods that would be INCLUDED on a level 3 dysphagia diet.

Open Ended

Give examples of foods that would be EXCLUDED on a level 3 dysphagia diet.

• hard foods (nuts, seeds)

• crunchy foods (raw veg, popcorn)

• sticky foods ​(laffy taffy)

• large chunks of food​

​Excluded

• soft-solid foods

• easy to cut into small pieces meats with extra gravy

• ​soft fruits and vegetables (bananas, peaches, steamed veg)

• bread with crust removed

​Included

Dysphagia Level 3

Open Ended

Give examples of foods INCLUDED on a level 2 dysphagia diet.

Open Ended

Give examples of foods EXCLUDED on a dysphagia diet.

• bread products

• crackers

• ​dry foods

• no large food chunks​

​Foods Excluded

• cohesive, moist semi-solid foods

• fork mashable foods

• ​ground, moist meats

• oatmeal, pancakes with syrup,​ mashed potatoes

​Foods Included

Diet Prescriptions: Dysphagia Level 2

Open Ended

Give examples of foods INCLUDED on dysphagia level 1 diet.

Open Ended

Give examples of foods EXCLUDED on dysphagia level 1 diet.

• whole foods ​

​Foods Excluded

• pudding-like foods ​

• smooth, pureed,​ homo

​Foods Included

Dysphagia Level 1 Diet

​You deserve a break, beautiful.

​

Fill in the Blank

How long does it take for tissue cell death to occur in patients with stroke? (Enter answer as X-XX minutes).

Open Ended

What are the two m

Ischemic (lack of blood flow) and Hemorrhagic (rupture and bleeding)

Open Ended

What are the risk factors of stroke?

​Risk Factors of Stroke

• hypertension

• diabetes

• ​smoking

• dyslipidemia

• ​BMI >25 kg/m

• ​weight gain >11 kg of 16 years

• ​waist-to-hip ratio >0.92 in men

​Modifiable Risk Factors for Stroke

• daily consumption of fresh fruit

• ​flavonoid consumption of >4.7 cups green tea/d

• ​fish consumption

• ​high HDL cholesterol

Subject | Subject

Some text here about the topic of discussion

Fill in the Blank

The classic keto diet has a ratio of _:_ fat to other.

Multiple Choice

On the keto diet, how many grams of carbs are allowed per 1000 kcal?

• 8 gram (4:1), 16 gram (3:1), 30 gram (2:1), 40-60 gram (1:1)

• 10 gram (4:1), 20 gram (3:1), 35 gram (2:1), 40-60 (1:1)

Open Ended

Parkinson's disease is caused by low levels of dopamine. What nutritional impacts will Parkinson's have on a pt?

Open Ended

What are the major physical changes associated with dementia?

Open Ended

Summarize what you know about neurological conditions.

• leading cancer causes and causes of death

• ​risk factors for cancer development

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​Cancer

​

Multiple Select

What are the top three new cases of cancer for females?

• Breast

• lungs and bronchus

• colon and rectum

• Thyroid

Multiple Select

What are the top three leading new cancer cases for males?

• Prostate

• Lung

• colon and rectum

• urinary bladder

Multiple Select

What are the top three deadliest causes of cancer for women?

• lung

• pancreas

• breast

• colon

Multiple Select

what are the top three deadliest causes of cancer for men?

• lung

• colon

• prostate

• pancreas

Open Ended

List as many cancer risk factors as you can.

Open Ended

Summarize what you know about cancer.

Why ​not draw a pretty picture?​

​Take another break

​

• prevention of HIV from mother to infant

• supplements

• lipodystrophy

• nutrient needs

• contraindicated foods

• criteria for wasting

• role of RDs in management

• ​viral load complications

​

​HIV/AIDS

​

Open Ended

Why would St. John's Wort be contraindicated for HIV/AIDS?

Decreases plasma levels of indinavir. It could cause drug resistence and treatment failure.

Fill in the Blank

____ supplements reduce blood levels of saquinavir.

Fill in the Blank

_______ can lesson metabolism of medications and increase toxicity.

Open Ended

Which three supplements are contraindicated for HIV/AIDS?

Open Ended

How does high viral load affect nutrition?

​How does viral load affect nutrition?

• high viral load is associated with changes ​seen in chronic inflammatory conditions and immune cell destruction

  • weight loss episodes

  • ​malnutrition suppresses immune system

  • hormonal response to infection can lead to complications (insulin, growth hormones, sex hormones)

  • tissue catabolism

  • reduced appetite

Open Ended

What is the role of RDs in HIV/AIDS?

Multiple Choice

What is the first step of MNT for HIV/AIDS?

• confirm HIV diagnosis

• assess weight hx

• get diet hx

• assess viral load and other related lab values

Open Ended

What are the goals of MNT for HIV/AIDS?

​MNT Goals for HIV/AIDS

• help maintain a LBM

• ​reduce the severity of HIV-related symptoms

• ​improve QOL

• ​enhance adherence and effectiveness of ART

Fill in the Blank

_____ is unintentional weight loss of lean body mass which could be caused by dietary intake, malabsoprtion, or increased metabolic rates from viral replication.

​Criteria for Wasting*

• loss of >10% body weight in 1 year

• ​loss of >5% body weight in 6 months

• BMI below 20

• Must meet 1 of these criteria to be dx with wasting ​

Subject | Subject

Some text here about the topic of discussion

Open Ended

What is the criteria for wasting?

​Criteria for Wasting*

• loss of >10% body weight in 1 year

• ​loss of >5% body weight in 6 months

• BMI below 20

• Must meet 1 of these criteria to be dx with wasting ​

Subject | Subject

Some text here about the topic of discussion

Multiple Choice

Johnny Bravo has been referred to you by his clinician. You ask about his weight history and he reveals that he is usually a muscular 200 pounds at 6'1". At the time of your appointment with him, he weighs 180 pounds. You find out this weight loss occured over the span of 5 months. Does he meet criteria for diagnosis of muscle wasting?

• Yes

• No

Multiple Select

Select the dx criteria for muscle wasting.

• loss of >10% in 1 year

• loss >2% in 6 months

• BMI under 20

• loss of >5% in 6 months

​What do you know? Another break. You're almost done!

Fill in the Blank

____ is a shift in body composition even though weight remains stable.

​HIV-associated lipodystrophy syndrome (HALS)

A syndrome that include lipoatrophy, lipohyperatrophy, or both

• lipoatrophy ​- subcutaneous loss of adipose tissue in face, butt, and peripheral

  • ​associated with insulin resistance, dyslipidemia, increased inflammation

• lipohypertrophy - ​adipose tissue accumulation, gradually leading to increases in abdominal fat

Fill in the Blank

Resting energy needs for people with HIV/AIDS may be increased by _-_% (Enter answer as X-XX%)

Multiple Choice

Which vitamin can increase risk of transmission of HIV from mother to child?

• A

• D

• E

• K

Multiple Choice

Would you recommend breast feeding if the mother had an HIV diagnosis?

• Yes

• No

Fill in the Blank

If EN is necessary, you should use ____ water.

You got this! ​Cry if you need to.

Open Ended

What foods are NOT recommended for people with HIV/AIDS?

​Foods not recommended

• raw eggs

• ​unpasteurized cheese

• ​uncooked seafood (sushi)

• raw, rare, or undercooked meats ​

Open Ended

Summarize what you remember from this section.