Advanced MNT Neurologic

Neurologic impairment can affect motor function, swallowing, cognitive function, energy/protein requirements, functional status, and ____

complications

Motor impairment following a stroke often manifests as hemiplegia or ____

paralysis

Visual and perceptual problems after neurologic injury include neglect and altered body ____

awareness

When starting a neurologic assessment, the three foundational questions are: what happened, what functions were affected, and how does that affect ____

nutrition

The 7 questions of the Neurologic MNT Assessment evaluate swallowing, self-feeding, understanding instructions, oral intake, energy/protein needs, complications, and post-____ factors

discharge

Under WHO classification, the physical functional involvement like hemiplegia is termed ____

impairment

Under WHO classification, the impact of a condition on daily roles and ADLs is termed ____

disability

Under WHO classification, the societal-level impact such as designated parking spaces is termed ____

handicap

Factors affecting stroke and neurologic rehabilitation include attitudes, financial resources, environmental barriers, and ____ barriers

educational and occupational

The overall goal of rehabilitation is to return the disabled individual to the community as a useful and productive ____

citizen

The 6 major goals of rehabilitation are improving function, promoting independence, adapting to disability, promoting life satisfaction, promoting optimal wellness, and preserving ____

self-esteem

A stroke is defined as a sudden disruption of blood supply to part of the brain that causes decreased ____ to brain cells

oxygen

Permanent death of brain cells occurs during a stroke, though uninjured cells may sometimes take over lost ____

function

Stroke accounts for ____% of total healthcare costs in the United States

2.4

In the United States, stroke is the ____ most common cause of death

5th

In Asia, stroke accounts for ____% of total deaths

1

The fatality rate of stroke ranges from ____% to ____%

10, 20

Most stroke-related deaths occur within ____ days of the event, with the first ____ hours being critical

30, 6

Stroke is the number one cause of long-term ____ in adults

disability

Following a stroke, ____ out of 10 patients require care in a Skilled Nursing Facility (SNF)

1

Following a stroke, ____ out of 10 patients achieve complete recovery, while ____ out of 10 are left with long-term disability

1, 8

The acronym FAST stands for Face drooping, Arm weakness, Speech slurred, and ____

Time to call 911

Additional warning symptoms of a stroke include sudden numbness, vision changes, and severe ____

headaches

Uncontrollable risk factors for stroke include age, gender, race, family history, and prior ____ history

stroke

Controllable risk factors for stroke include diet/exercise, smoking/drinking, high blood pressure/cholesterol, heart disease, and ____

diabetes

Ischemic stroke accounts for ____% of all strokes and is caused by a blood clot blocking blood flow

80

An embolic ischemic stroke occurs when a blood clot forms ____ the brain and travels to the brain

outside

A thrombotic ischemic stroke occurs when a blood clot forms in an artery ____ the brain

within

A Transient Ischemic Attack (TIA) is a "mini stroke" causing temporary blood flow obstruction lasting for ____

minutes

A hemorrhagic stroke occurs when an artery in the brain ruptures or leaks, putting pressure on ____

brain cells

The major controllable risk factor for hemorrhagic stroke is high ____

blood pressure

A hemorrhagic stroke affecting surrounding brain tissue is termed ____, whereas one between the skull and brain is termed ____

intracerebral, subarachnoid

Left-sided brain injury controls the ____ side of the body and typically results in speech/language deficits termed ____

right, aphasia

Patients with left-sided brain injury generally display a behavioral style described as ____ and ____

slow, cautious

Left-sided brain damage impairs understanding of spoken/written language, verbal memory, logic, and ____

sequencing

Right-sided brain injury controls the ____ side of the body and affects spatial relationships, abstract meaning, and visual perception

left

Patients with right-sided brain injury display a behavioral style described as ____ and ____, often showing poor judgment

quick, impulsive

Right-sided brain damage typically causes left-sided neglect, loss of "big picture" thinking, and speech articulation deficits termed ____

dysarthria

Perceptive disorders following a stroke include body image distortion (unawareness/neglect and denial) and spatial distortion (hemianopsia and defective spatial ____)

orientation

In stroke assessment, hemiplegia prevents ____, whereas neglect causes failure to recognize food

self-feeding

In stroke assessment, visual changes cause difficulty locating food, and impulsivity creates severe ____ concerns

safety

Dysphagia following stroke represents both a nutrition issue and a safety issue due to the risk of ____

aspiration

Objective swallowing studies used to evaluate post-stroke dysphagia include FEES and ____ swallow

barium

FEES stands for Flexible Endoscopic Evaluation of ____

Swallowing

Standardized dysphagia diet frameworks classify liquid and food consistencies, such as IDDSI levels ranging from thin liquids to ____ foods

regular

MNT primary prevention for stroke emphasizes lifestyle and the ____ diet

Mediterranean

Key neuroprotective dietary components after stroke include nuts, low-fat dairy, whole grains, antioxidant-rich fruits/vegetables, and ____ fatty acids

omega-3

Energy requirements for a sedentary stroke patient during rehabilitation are ____ kcal/kg

20 to 25

Energy requirements for a more active stroke patient during rehabilitation are ____ kcal/kg

30

Stroke calorie needs can be estimated as REE × ____ if in bed most of the day, and REE × ____ if out of bed most of the day

1.2, 1.3

Protein requirements for stroke patients are ____ g/kg when chronically at rest, and ____ g/kg when moderately active

1.0, 1.5

The three core MNT priorities for stroke are dysphagia management, nutrition adequacy, and reducing ____ risk

cardiovascular

Traumatic brain injury (TBI) results from a violent blow/jolt to the head or a penetrating object such as a ____

bullet or skull fragment

The most common cause of traumatic brain injury is ____

falls

Major causes of TBI include falls, vehicle-related collisions, violence, sports injuries, and ____

explosive blasts

Physical symptoms of mild TBI include headache, nausea/vomiting, fatigue, speech problems, dizziness, and loss of ____

balance

Sensory symptoms of mild TBI include blurred vision, tinnitus (ringing in ears), altered taste/smell, and sensitivity to ____

light or sound

Cognitive symptoms of mild TBI include loss of consciousness for seconds to minutes, confusion, memory/concentration problems, and ____ changes

mood

Physical symptoms of moderate-to-severe TBI include prolonged loss of consciousness, persistent headache, seizures, pupil dilation, and clear fluid draining from the ____

nose or ears

Cognitive symptoms of moderate-to-severe TBI include profound confusion, agitation, combativeness, slurred speech, and ____

coma

TBI structural injury types include fractures, concussion, contusion, laceration, and ____ axonal injury

diffuse

A concussion is described as "jostling" of brain tissue, whereas a contusion is described as ____ of brain tissue

bruising

Diffuse axonal injury involves the shearing of axons caused by ____ acceleration

rotational

Altered states of consciousness following severe TBI include coma, vegetative state, minimally conscious state, and ____

brain death

Physical complications of TBI include seizures, hydrocephalus, infections, blood vessel damage, headaches, and ____

vertigo

Hydrocephalus in TBI refers to fluid buildup in the brain that elevates ____ pressure

intracranial

TBI at the base of the skull damages cranial nerves, resulting in facial paralysis, loss of taste/smell, vision loss, swallowing problems, and ____

hearing loss or dizziness

Executive functioning deficits following TBI impair problem-solving, multitasking, organization, planning, and decision-____

making

Repeated or severe TBI increases the risk of degenerative brain diseases including Alzheimer's, Parkinson's, and ____

dementia pugilistica

Dementia pugilistica is a degenerative brain condition specifically associated with repetitive head impacts in career ____

boxing

Key TBI prevention measures include seat belts, car seats, airbags, helmets, avoiding driving under the influence, and paying attention to ____

surroundings

The Glasgow Coma Scale (GCS) evaluates 3 behaviors: eye opening, motor response, and ____ response

verbal

GCS scores range from 3 to 15, where a score of 13–15 indicates ____ injury, 9–12 indicates ____ injury, and 3–9 indicates ____ injury

mild, moderate, severe

Computerized tomography (CT) uses x-rays to detect fractures, hemorrhage, hematomas, contusions, and tissue ____

swelling

Magnetic resonance imaging (MRI) uses radio waves and magnets to evaluate brain structure after the patient's condition ____

stabilizes

An intracranial pressure monitor uses a probe inserted through the ____ to detect swelling

skull

TBI causes severe metabolic stress and hypercatabolism, resulting in daily fasting nitrogen excretion of ____ g/day

14 to 25

Early enteral nutrition in TBI should begin as trophic tube feedings into the ____ within ____ days post-injury

jejunum, 5 to 7

Baseline energy expenditure in TBI ranges from 75% to 250% of BEE, typically calculated as BEE × ____

1.4 to 1.6

If a TBI patient is treated with barbiturates, energy needs drop to ____% of BEE

100 to 120

Protein requirements during the acute phase of TBI are ____ g/kg

1.5 to 2.0

Specialized nutrients considered in TBI care include choline, DHA, EPA, and a short-term ____ diet if seizures occur

ketogenic

The primary MNT priorities for TBI are managing catabolism, providing high protein, and initiating early ____

nutrition support

Spinal cord injury (SCI) is a major cause of disability occurring most commonly in young males aged ____ years

17 to 25

The most common cause of spinal cord injury is ____

motor vehicle accidents

Causes of SCI include motor vehicle accidents, violent trauma, falls, sports injuries, and ____

tumors or infections

In a complete spinal cord injury, all sensory feeling and motor control are lost below the injury, whereas in an incomplete injury ____ function is preserved

some

Tetraplegia (quadriplegia) affects the arms, hands, trunk, legs, and pelvic organs, whereas paraplegia affects the trunk, legs, and ____

pelvic organs

Emergency signs of SCI include extreme neck/back pain, paralysis, numbness/tingling, loss of bowel/bladder control, impaired breathing, and an oddly positioned ____

neck or back

Due to reduced mobility, chronic SCI results in a metabolic shift characterized by lower energy expenditure and high risk for ____

weight gain and obesity

Accepted target body weights after SCI are 10–15 lbs less than IBW for paraplegia, and ____ lbs less than IBW for tetraplegia

15 to 20

Calorie equations for chronic SCI patients generally overpredict needs, requiring ____% fewer calories than calculated

25

Energy needs in chronic paraplegia are approximately ____ kcal/kg

27.9

Energy needs in chronic tetraplegia are approximately ____ kcal/kg

22.7

In acute SCI, energy needs are estimated using indirect calorimetry or HBE × ____, with protein needs at ____ g/kg IBW

1.3, 2.0

Protein needs in chronic paraplegia and tetraplegia are ____ g/kg

0.8 to 1.0

Neurogenic bowel and constipation in SCI are managed with high fiber and adequate ____

hydration

Pressure injuries in SCI require adequate energy and ____ for tissue healing

protein

Bone mass loss in chronic SCI is managed with supplementation of ____ and ____

calcium, vitamin D

Common long-term complications of SCI include altered sensation, loss of bowel/bladder control, muscle spasms, sexual dysfunction, pulmonary compromise, skin breakdown, and ____

neurogenic bowel