Term
| With COPD pts, the increased work of breathing increases the what? |
|
Definition
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|
Term
| COPD pts have chronic SOB and are O2 dependent, in what 2 ways do they have difficulty getting the nutrition they need? |
|
Definition
challenging to shop and prepare meals
mayhave changes in taste due to excess sputum |
|
|
Term
| Does dairy increase mucous and thereby worsen SOB? |
|
Definition
| no, unless have an allergy to it. |
|
|
Term
| Why do COPD pts have multiple infections? |
|
Definition
| due to their chronic use of steroids |
|
|
Term
Steroid use is good bc ______
Bad bc_______. |
|
Definition
good: increases people's appetites
bad: they increase blood sugars and can cause steroid induced diabetes... this can only be treated with insulin, not diet |
|
|
Term
| Why do people with COPD have swallowing dysfxn with eating? |
|
Definition
-when people are unable to breathe they do not wan to eat bc disrupts breathing
-aspiration pneumonia can be a problam
-may need to do enteral feeds
-may not be able to eat around a trach if pt has one.
-If are so malnourished and they do get aspiration pneumonia, the abx will not help the pneumonia... bc when become really sick body feeds on muscle protein stores. |
|
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Term
| In cystic fibrosis, how does malabsorption occur? what does this cause? |
|
Definition
through mucous obstruction of the pancreas
this causes growth retardation and issues with pancreatic enzymes (the body makes insulin but it cannot leave the pancreas... these patients need insulin)
cannot absorb vitamins and minerals properly (A,D,E,K) |
|
|
Term
| In cystic fibrosis, why are there increased calorie needs? |
|
Definition
due to increased work of breathing
need high calorie foods and supplements and supplemental enteral feeds |
|
|
Term
| What is the male weight gain goal in CF? female? |
|
Definition
23
22
-weight gain can be done by insulin alone but that is not healthy... want a healthy weight gain (through exercise) bc want to put on lean tissue not fat. |
|
|
Term
| Do you want CF pts to gain the weight in the ICU? |
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Definition
| NO, want them to gain it at home once they feel better and are able to put on lean muscle and not just fat. |
|
|
Term
| What is given to CF pts in the ER? |
|
Definition
| elemental formulas, bc they dont need to be broken down by the pancreas.... these are EXPENSIVE! |
|
|
Term
| Is there any conclusive evidence that asthma can be improved by diet changes? (besides food allergies) |
|
Definition
|
|
Term
| Why is there weight loss with lung cancer? |
|
Definition
due to N/V/D associated with treatments
can have swallowing dysfxn if the cancer is in the trachea |
|
|
Term
| What may help lung cancer pts get them through the lung cancer since they have no appetite and a change since of tasre due to chemo and surgery? |
|
Definition
feeding tube.
-dont need it once the cancer is gone. |
|
|
Term
| What is obstructive sleep apnea mostly caused by? |
|
Definition
| excess weight, these pts need to lose weight |
|
|
Term
| Nearly ___________ Americans have at least one form of CVD |
|
Definition
82.6 million
-HTN (76 million)
-CHD (16 million)
-Stroke (7 million)
-Heart failure (5.7 million) |
|
|
Term
| As defined by the AHA, metabolic syndrome is when you have 3 or more of the following.. |
|
Definition
Abdominal obesity
Men > 40”
Women > 35”
Triglyceride level of 150 mg/dL or greater
HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
Systolic blood pressure of 130 mm Hg or greater
Diastolic blood pressure of 85 mm Hg or greater
Fasting glucose of 100 mg/dL or greater
Insulin resistance or glucose intolerance |
|
|
Term
| What might insulin resistant pts have? |
|
Definition
| darkened lines around their neck |
|
|
Term
| What is the main cause of cardiac dz? |
|
Definition
|
|
Term
| What kind of pts have a higher triglyceride and cholesterol levels? |
|
Definition
| pts with central obesity when the abd is fat |
|
|
Term
| Why are women expected to have a higher HDL level than men? |
|
Definition
| bc estrogen increases HDL in the bloodstream |
|
|
Term
| A high serum cholesterol level causes what? |
|
Definition
|
|
Term
| What are the desirable levels for total cholesterol, HDL, LDL, and triglycerides? |
|
Definition
total cholesterol: <200
HDL: >45 women and >35 men
LDL: <100 and <70 with other risk factors
Triglycerides: <150 |
|
|
Term
| What are 5 factors that modify LDL goals? |
|
Definition
cigarette smoking
HTN (BP>140/90 or is on HTN meds)
Low HDL (<40 mg/dl)
-HDL >60 mg/dl
Family Hx of premature CHD:
-CHD in male 1st degree relative <55y
-CHD in female 1st degree relative <65y
Age
-Men >45y
-Women >55y |
|
|
Term
| Dietary cholesterol raises total cholesterol and LDL, but not as significantly as what? |
|
Definition
|
|
Term
| what is the threshold effect with dietary cholesterol? |
|
Definition
| as cholesterol intake is increased, a smaller increase in cholesterol levels are seen |
|
|
Term
| Dietary SFA and cholesterol have a __________ effect on LDL level. |
|
Definition
|
|
Term
| What are the food sources of cholesterol? |
|
Definition
| meats, high-fat dairy products, eggs |
|
|
Term
| saturated fats and trans fats drive up LDL and TGs and drive down what? |
|
Definition
|
|
Term
| What is the goal for saturated fat intake? |
|
Definition
<7% total calories
15 grams on 2000 calorie diet |
|
|
Term
| What is the goal for trans fat intake? |
|
Definition
<1% total calories
2 g on 2000 calorie diet |
|
|
Term
| What is the goal for cholesterol intake? |
|
Definition
<200 mg per day (for those who have CHD or LDL >100)
<300 mg per day for all others |
|
|
Term
| When is the risk reduction most effective? |
|
Definition
| when SFA and TFA are replaced with unsaturated fats, particularly omega-3 fatty acids |
|
|
Term
|
Definition
drive up HDL
have less thrombotic and pro-inflammatory effects |
|
|
Term
|
Definition
man made fat.. taste good and elongate the shelf life of food
-so prety much want to eliminate these from your diet |
|
|
Term
| The type of fat in meat from an animal on a corn fed diet is Omega 6s, which cause what? |
|
Definition
| more thrombotic and pro-inflammatory metabolites |
|
|
Term
| What are the 3 omega-3 fatty acids? |
|
Definition
|
|
Term
|
Definition
reduces TG levels
decreases platelet adhesion
favorably effects endothelial fxn
decreases vasoconstriction
reduces inflammation
decreased ventricular arrhythmias |
|
|
Term
|
Definition
| protects against CVD by interfering with the production of proinflammatory eicosanoids produced via the N-6 pathway |
|
|
Term
| Secondary prevention with omega-3 fatty acids is done when pt has many risk factors and need to do a little more than just eat fish, what is this prevention? |
|
Definition
| 850-1000 mg of EPA and DHA |
|
|
Term
| what is primary prevention with omega-3 fatty acids? |
|
Definition
2 or more servings (4 oz each) of oily fish/ week
inclusion of foods rich in ALA |
|
|
Term
| For high triglyceride levels, how much omega-3s should be taken? |
|
Definition
|
|
Term
| T or F: Omega-3 fatty acid diets should be supplemented under the care of physician |
|
Definition
TRUE
-EPA and DHA enhance blood thinner effects, so PT and PTT need to be watched, don't want them to come in with a bleed. |
|
|
Term
| What are the sources of DHA/EPA? |
|
Definition
Herring
Salmon
Tuna
Mackerel
Sardines
Trout |
|
|
Term
| What are the sources of ALA? |
|
Definition
Walnuts
Walnut oil
Flaxseed & Flax oil (so small that can get through the body whole, so need to grind it up)
Soybeans & Soybean oil
Canola oil
Pumpkin seeds |
|
|
Term
| At the end of the day, still worried about weight gain so pt still needs to take their sources on omega-3 how? |
|
Definition
|
|
Term
| FDA requires all manufacturer to list trans fat content on food label, what are the limitations on this? |
|
Definition
if less than 1 serving of food has <.5 g they are allowed to round it down to 0... so they just list the servings as being smaller.
So must look at the ingredients, trans fats are anything with hydrogenated oil |
|
|
Term
| Trans fatty acids are produced by the hydrogenation of what? |
|
Definition
|
|
Term
| What are the food sources of trans fatty acids? |
|
Definition
| shortening, margarine, commercial frying fats, high fat baked goods. |
|
|
Term
| Trans fats are rigid and not smooth like natural fats... this is why a diet high in trans fats is associated with what? |
|
Definition
| an increased risk of cancer |
|
|
Term
| High fiber diets (>25 g) are associated with what? |
|
Definition
|
|
Term
| Soluble fiber has a greater LDL lowering potential than what? |
|
Definition
|
|
Term
| What should you aim for per day with fiber? soluble fiber? |
|
Definition
fiber: 25-30 g/ day
soluble fiber: 7-13 g/ day |
|
|
Term
| Soluble fiber removes what from the diet? |
|
Definition
| cholesterol, forms a gel in the small bowel and those bile salts (made from cholesterol) become trapped in it. |
|
|
Term
| What are the sources of soluble fiber? |
|
Definition
kidney beans: 6g
Oats: 4g
strawberries: 3.4 g
metamucil: 2.4 g
sweet potatoes: 2.8 g
apple: 3 g |
|
|
Term
| How many plant sterols and stanols do you need per day? what does this cause? |
|
Definition
2-3 g
causes a 6-14% decrease in LDL and a 4-9% decrease in TG
can decrease fat-soluble vitamin absorption |
|
|
Term
| plant sterol displaces __________ in micelles. |
|
Definition
|
|
Term
| How should you replace food with sterol sources? |
|
Definition
|
|
Term
| What are the natural sources of plant sterols and stanols? |
|
Definition
| avocado, corn oil, soybeans, chickpeas, almonds, olive oil |
|
|
Term
| What are the natural sources of plant sterols and stanols? |
|
Definition
| avocado, corn oil, soybeans, chickpeas, almonds, olive oil |
|
|
Term
| What are you checking when you check cholesterol? |
|
Definition
| you're measuring the amt of cholesterol in micelles floating around in the bloodstream |
|
|
Term
| What are some commercially produced sterol and stanol product supplements? (they will be placed in a food that has fat in there bc they are a fat) |
|
Definition
benecol
promise ACTIV
Smart balance omega peanut butter
minute maid premium heart wise orange juice |
|
|
Term
|
Definition
National Cholesterol Education Program
-started in 1985, now with third report
focuses on hypercholesterolemia
Designed ATP III
-calls for more LDL lowering therapy
-focuses on primary prevention for those with multiple risk factors
-ATP III dietary recommendations: therapeutic lifestyle change (TLC) diet |
|
|
Term
| What is the nutrient composition of TLC? |
|
Definition
Total kcals-->
saturated fat: <7%
PUFA: up to 10%
MUFA: up to 20%
total fat: 25-35%
CHO: 50-60%
fiber: 20-30 g/d
protein: approx 15% of total kcal
cholesterol: <200mg/d
total kcal: balance energy intake and expenditure to maintain desirable wt and or prevent wt gain
*vast majority of diet should come from CHOs |
|
|
Term
| what are some dietary approaches to stop HTN (DASH)? |
|
Definition
Low sodium 1500mg/day
High potassium 4700mg/day
High fiber 30g/day
Total fat 27% calories
Saturated fat 6% calories
Cholesterol 150mg/day |
|
|
Term
| Excessive consumption of alcohol is associated with increased risk of what? |
|
Definition
|
|
Term
| Moderate levels of alcohol are associated with decreased risk of MI and CHD mortality, what is "moderate"? |
|
Definition
1 glass/ day for women
2 glasses/ day for men |
|
|
Term
| Is supplementation of antioxidants and B-vitamins recommended for CVD prevention? |
|
Definition
No, esp folic acid and antioxidant supplementation
-Vitamin E and C shouldn't be given
-vitamin k is usually contraindicated with the use of anticoagulants. |
|
|
Term
| Moderation is key with caffeine and risk for CVD, how should this be done? |
|
Definition
1-2 cups of coffee
-best to use paper filter to reduce saturated fats |
|
|
Term
| When does leah worry about caffeine intake? |
|
Definition
| if in hospital for an arrhythmia or have caffeine sensitivity |
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